Current Organisation

Current Job Title

Biography

Project Title

EDCTP-GSK fellowship: Impact of Diabetes on TB disease and Treatment Outcome in Ghana

EDCTP Project Call

Senior Fellowship (SF)

Host Organisation

Project Objectives

Specific Objectives To determine the prevalence of DM among newly diagnosed TB cases and TB among diabetic cases To determine the evolution of glucose tolerance during and after TB treatment To conduct pharmacokinetic and pharmacodynamic studies in Ghanaian patients with TB and DM to understand the effect of DM on TB drugs and impact of DM drugs on TB treatment. To determine the DR patterns of mycobacterial isolates from TB-DM cases To determine the effect of DM on evolution and occurrence of specific MTBC lineages in Ghana.

Study Design

Longitudinal study

Project Summary

Tuberculosis (TB), which has killed more humans than any other infectious disease is still a major global health problem. Established risk factors for TB include the HIV pandemic, the occurrence of strains resistant to anti-TB drugs. Diabetes mellitus (DM) is also increasingly becoming a worldwide chronic health condition, which can be attributed to increases in obesity, changing patterns of diet and physical activity as well as ageing. DM has been associated with reduced T cell response and neutrophil functional activity. Reports of many studies in different parts of the world indicated a higher DM prevalence among newly diagnosed TB cases compared to the general population. However, unlike HIV/AIDS, the relationship between TB and DM has not been given much attention but requires attention, especially in low-income countries where 3/4 of diabetic patients live and are also battling with TB. This proposed study aims to determine the effect of DM on incidence and treatment outcome of TB in Ghana, the pharmacokinetics of anti-TB drugs, the association of TB-DM and drug resistance and evolution of distinct TB lineages. TB cases will be recruited from both the chest clinic and the diabetic clinic following the national guidelines from the respective health facilities. Every case will have a baseline HBA1c and Fasting Blood Glucose (FBG) done. Results will be used to classify patients into normal; impaired plasma glucose and diabetes as per the American Diabetes Association guidelines. All cases will be followed during treatment after consent has been sought. Detailed clinical and demographic data including lesion location by x-ray, previous treatment will be collected. We will re-test the HbA1c levels among all DM cases at 2, 5 and 6 months of treatment to determine glycemic control. In addition, the treatment outcome and other complications during treatment will be documented. Laboratory analyses will include pharmacokinetics of anti-TB and diabetic drugs, culturing and genotyping of Mycobacterium tuberculosis complex isolates, drug susceptibility testing of all mycobacterial isolates. Association between any of the measured variables, clinical and demographic variables and DM will be calculated using standard statistics such as logistic regression analysis. At the end of the study, findings will contribute to a better understanding of DM on TB incidence and treatment outcome as well as management of the two co-morbidities. This project will also build capacity which will be useful for future trials.